🧮 Can I use my HSA for insurance premiums?

Usually no, with four exceptions: COBRA, coverage while on unemployment, long-term care insurance, and Medicare premiums after 65.

Ordinary health insurance premiums are not qualified expenses. Four exceptions are:

  1. COBRA continuation coverage — premiums qualify while you're on COBRA
  2. Coverage while receiving unemployment compensation — health premiums qualify during that period
  3. Long-term care insurance — qualifies up to an age-based annual limit set by the IRS
  4. Medicare premiums after 65 — Parts A, B, C, and D all qualify

Medicare supplement (Medigap) policies do not qualify, which is a common and expensive mix-up.

The Medicare exception is a genuinely large benefit. Part B alone runs well over $2,000 a year per person, and paying it from an HSA converts that into a tax-free expense for the rest of your life.

Note the asymmetry after 65: you can pay Medicare premiums from an HSA, but you can no longer contribute once you enroll in Medicare.

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